Anybody ever seen anything like this??

[Saf1]

Newish FNP working in urgent care. Last night one of the MAs pulled me out of an exam room for an emergency (I'm the only provider on site). Kiddo maybe 6-8 years old slumped over being carried by dad...we got him into an exam room and kiddo's breathing is super distressed. His fingers and toes are cold so we're struggling to get vitals (we don't have a lot of fancy monitoring stuff) but he's clearly altered, eyes wide open rolling all over the place, not focusing on anyone and only minimally responding to his mother's voice. His lungs are completely clear, no stridor, no apparent obstruction. Just very disorganized breathing pattern. Couldn't get a pulse ox to read so put 2L simple mask on just since he was so distressed. Sent the MA to call an ambulance. Finally pulse ox pops up 100% so I took the mask off to see if he'd maintain but he started to desat right as EMS walked in. They also said his airways weren't obstructed and his lungs were clear. They didn't seem to know either. Scooped the kid up and took him to Children's up the road from us. No *clue* what was wrong with the kiddo. Maybe toxin or medication that he got into? Something neurogical? No fevers but kiddo had been home sick with a cold but his symptoms were very sudden onset (they live near the urgent care and parents had dashed straight to us when he got sick). Anyhow, I'm hoping he did OK...we never even got him registered and I don't think there's any way to follow up. Super scary but also super curious.

[nursetim, NP]

On 9/2/2021 at 7:08 AM, ZenLover said:

I saw something similar in a grown man that came into our ED and up to our ICU.  His pH was 7.02 and it was metabolic acidosis, not respiratory driven.  They were thinking it was because he had taken a new prescription of Metformin....but no way it was that without overdose so quickly.  But what you describe sounds like a similar presentation to this man.  He did report having had diarrhea for a few days before, but his kidneys were failing and he was very average to small framed.  The metformin had been started as aggressive measures for "pre-diabetes" at low daily dose.  Nothing that one would expect that kind of severe reaction. He had no prior known medical history and his previous labs should healthy kidneys that were now failing fast. My fear is Ivermectin, especially the over the counter animal version.  It can cause severe diarrhea and I am afraid people are so terrified of COVID they are trying to self medicate inappropriately.  Despite intubating him and starting emergent dialysis which quickly turned into CRRT we lost him.  Still waiting on toxicology labs to understand how and why.  Now I'm afraid it isn't just COVID we are fighting, but the fear, the misinformation and the myriad of ways people can harm themselves and their loved ones. 

It has always been fear we have fought, media driven fear.

[2BS Nurse, BSN]

"One of the things I'm learning in urgent care is to know not just my limitations, but the limitations of my setting. It's humbling indeed"

Yes, my company would post online symptoms of "when to go to urgent care vs ER". Unfortunately, patients would ignore them and come to the UC anyway. All we could do was call 911, perform EKG and start IV. Very frustrating indeed, but we needed to collect that money!!

[FiremedicMike, BSN, RN, EMT-P]

@Saf1 did you ever get follow-up on this patient?

[WonderousIvy, BSN]

Had a child come in like this turned out to be septic